Theories of reasoned action and planned behavior as models of condom use: a meta-analysis

Development of the eTAP: A brief measure of attitudes and process in e-interventions for mental health

BACKGROUND

Considerable evidence supports the efficacy of e-interventions for mental health treatment and support. However, client engagement and adherence to these interventions are less than optimal and remain poorly understood.

OBJECTIVE

The aim of the current study was to develop and investigate the psychometric properties of the e-Therapy Attitudes and Process questionnaire (eTAP). Based on the Theory of Planned Behaviour (TPB), the eTAP was designed to measure factors related to client engagement in e-interventions for mental health.

METHODS

Participants were 220 adults who reported current use of an e-intervention for mental health support. Participants completed the eTAP and related measures, with a subsample of 49 participants completing a one-week follow up assessment.

RESULTS

A 16-item version of the eTAP produced a clear four-factor structure, explaining 70.25% of variance. The factors were consistent with the TPB, namely, Intention, Subjective Norm, Attitudes, and Perceived Behavioural Control. Internal consistency of the total and subscales was high, and adequate to good one-week test retest reliability was found. Convergent and divergent validity of the total and subscales was supported, as was the predictive validity. Specifically, eTAP Intentions correctly predicted engagement in e-interventions with 84% accuracy and non-engagement with 74% accuracy.

CONCLUSIONS

The eTAP was developed as a measure of factors related to engagement and adherence with e-interventions for mental health. Psychometric investigation supported the validity and reliability of the eTAP. The eTAP may be a valuable tool to understand, predict, and guide interventions to increase engagement and adherence to e-interventions for mental health.

A More Understanding about AIDS: Design and Assessment of Validity and Reliability of Several New Scales

Introduction: Given the high cost of AIDS, research on high-risk behaviors associated with AIDS is an essential requirement today. Therefore, the present study aimed to construct and standardize tests associated with AIDS-related risky behaviors. Methods: To assess the validity of the questionnaires, the experts' viewpoints from different domains were qualitatively and quantitatively included. Additionally, to assess the reliability of the questionnaires, a sample of 31 subjects was selected and then examined on two separate occasions in a fortnight's time. Then, the validity and reliability of the instruments were assessed in a sample of 475 subjects. Results: The results of exploratory factor analysis showed that for AIDS health literacy and AIDS risk perception questionnaires two factors are extractable; while for the questionnaires of self-efficacy in controlling risk behavior and controlling risk behavior associated with AIDS one factor is extractable. Finally, 14 items were approved for each of the AIDS health literacy and self-efficacy in controlling risk behavior questionnaires; while 13 items were approved for each of the controlling risk behavior associated with AIDS and AIDS risk perception questionnaires. Each of the four questionnaires had a good internal consistency (Cronbach's Alpha > 0.70). Interclass Correlation Coefficient (ICC) amounts related to the test-retest reliability were greater than 0.80, which indicates the reliability of the instruments. Conclusion: According to the results of the present study, it was concluded that all four AIDS-related questionnaires enjoyed acceptable validity and reliability.

Understanding use of consumer protection tools among Internet gambling customers: Utility of the Theory of Planned Behavior and Theory of Reasoned Action

Consumer protection tools such as activity statements, deposit limits, and temporary self-exclusion are provided by most Internet gambling websites to minimise gambling related harms through the prevention of problems and enhancement of controls for those at risk of disordered gambling. However, customer engagement with these tools is very low. Developing a theoretical framework to understand the reasons individuals use consumer protection tools is important to design strategies to increase uptake. Customers of Australian online wagering sites (N = 564) completed an online survey with a follow-up (N = 193) to assess whether the Theory of Planned Behaviour explained intention to use tools and actual behaviour with additional consideration of past tool use. Results showed that past tool use, attitudes and subjective norms, but not perceived behavioural control, were positively correlated with intention to use consumer protection tools. Intention to use the tools prospectively predicted actual tool use. The study validates past behaviour as a predictor of intention, and intention representing a significant predictor of future behaviour. The Theory of Reasoned Action (without the inclusion of perceived behavioural control), rather than Theory of Planned Behaviour, appears to be a suitable conceptual model to understand consumer protection tool use for Internet wagering websites. Use and application of consumer protection tools on gambling websites is not perceived as effortful, but under volitional control and straightforward. Positively influencing individual attitudes, perceived views of others and past tool use could increase online wagering customers' use of consumer protection tools.

Self-efficacy and response-efficacy: critical components of sexual and reproductive health interventions targeting condom use intention among American Indian adolescents

The Respecting the Circle of Life (RCL) intervention is a comprehensive, skills-based sexual/reproductive health program shown to be effective for reducing sexual risk among American Indian (AI) adolescents (13-19 years of age). This paper seeks to identify critical program components of the RCL intervention for replication of impacts on condom use intention (CUI) when scaling to additional communities. RCL was tested among AI adolescents through a cluster randomized controlled trial (N = 267) embedded in an 8-day basketball camp. Data were collected at baseline, immediately post-camp, at 6 and 12 months post-camp. Previously established predictors of CUI that were statistically significantly impacted by RCL at the post-camp time point were tested as mediators of RCL impact on CUI. Condom use self-efficacy and response efficacy fully mediated the effect of RCL on CUI. The indirect path through condom use self-efficacy had the greatest effect on CUI, explaining 79% of the direct effect. When stratified by gender, there was only evidence of mediation among girls. Results indicate condom use self-efficacy and response efficacy are critical components of the RCL intervention for AI girls, and sexual/reproductive health programs should include practical skills training to improve these constructs to maximize intervention impact on CUI.

Physical Activity in Peri-Urban Communities: Testing Intentional and Implicit Processes within an Ecological Framework

BACKGROUND

Given the substantive health inequalities in peri-urban communities and the potential for physical activity to promote health in these communities, identifying modifiable physical activity determinants in this population is important. This study explored effects of the peri-urban environment and psychological constructs on physical activity intentions and behavioural automaticity guided by an integrated theoretical framework.

METHODS

Peri-urban Australians (N = 271) completed self-report measures of environmental (i.e. physical/social environment, and neighbourhood selection), motivational (i.e. autonomous motivation), and social cognition (i.e. attitudes, norms, and perceived behavioural control [PBC]) constructs, past behaviour, intentions, and automaticity.

RESULTS

A well-fitting path analytic model revealed that: autonomous motivation predicted all social cognition constructs; subjective norms and PBC, but not attitudes; autonomous motivation predicted intentions and automaticity; and subjective norms and PBC mediated effects of autonomous motivation on intentions. Of the environmental constructs, only neighbourhood selection was related to intentions, mediated by PBC.

CONCLUSIONS

Autonomous motivation is an important correlate of physical activity intentions and automaticity, and subjective norms and PBC also related to intentions. Individuals perceiving a supportive environment were more likely to report positive PBC and intentions. Targeting change in autonomous motivation, and normative and control beliefs may help enhance physical activity intentions and automaticity in peri-urban communities.

Parent-Adolescent Communication About Sex and Condom Use Among Young Men Who Have Sex With Men: An Examination of the Theory of Planned Behavior

Background

Young men who have sex with men (YMSM) are at disproportionate risk for HIV infection. Parent-adolescent communication about sex, particularly mother-adolescent communication, protects against adolescent sexual risk behavior. However, it is unclear whether these findings generalize to YMSM.

Purpose

The current study used the theory of planned behavior as a framework to examine how YMSM perceptions of parent-adolescent communication about condoms are associated with determinants of condom use and condomless anal sex among YMSM.

Method

YMSM ages 14-18 (M = 16.55) completed an online survey (n = 838). Associations between several domains of parent-adolescent communication about condoms (i.e., frequency and specificity, quality, and negative emotionality) and condom-related attitudes, norms, perceived behavioral control, and intentions, as well as instances of condomless anal intercourse (CAI), were examined with structural equation modeling.

Results

Multiple facets of mother-adolescent communication were associated with attitudes about condoms, subjective norms for condom use, perceived behavioral control, intentions to use condoms, and indirectly, instances of CAI. Father communication was not associated with determinants of condom use behavior.

Conclusions

Parent-adolescent communication about condoms is associated with determinants of condom use behavior among YMSM, and mother communication exerted an indirect influence on HIV-related sexual risk behaviors. Interventions designed to enhance parent- adolescent communication about condoms could prove efficacious in reducing HIV infections among YMSM.

Intention to start ART after the launch of expanded treatment strategy among people living with HIV in China: a behavioral theory-based cross-sectional study

This study investigated the prevalence of intention to start antiretroviral therapy (ART) immediately among people living with HIV (PLWH) in China and associated perceptions toward ART based on behavioral theories. The study was initiated after the launch of an expanded ART strategy. A cross-sectional study was conducted among 450 PLWH who were ART naive in the city of Guangzhou, China, from June 2016 to February 2017. Among the participants, 311 (69.1%) showed intention to start ART immediately. The summary logistic regression analysis indicated that intention to start ART immediately was significantly associated with perceived severity [multivariate odds ratios (OR_m) = 1.62, 95%CI = 1.15-2.28, p < 0.01], perceived barriers (OR_m =0.56, 95%CI = 0.38-0.84, p < 0.01), self-efficacy (OR_m =2.90, 95%CI = 2.05-4.09, p < 0.001), and subjective norms (OR_m =1.95, 95%CI = 1.17-3.25, p < 0.05). The intention to start ART immediately among PLWH in Guangzhou was below the 90-90-90 target. Further promotion research should focus on these perceptional factors.

From Values to Behavior: Proposition of an Integrating Model

Human values are at the heart of our lives. We all hold a set of values that influence our actions. The protection of the natural environment is no exception to this rule. That is why the study of human values is key to reaching the imperative of sustainability. In this conceptual paper, we aim to (1) integrate the key theories and models explaining the influence of human values on behavior and to (2) identify factors that might have previously been overlooked. Drawing from a range of disciplines, this article proposes an integrated model mapping the influence of human values on behavior. It also puts forward the concept of consequences as an emerging factor that could play an important role in this relationship. Recommendations are to extend the research to an empirical investigation of the model and to develop the definition of the concept of consequences and the role they play in the influence of values on consumer behavior.

Dual Control Model in a Cross-Cultural Context: Role of Sexual Excitation in Sexual Response and Behavior Differences Between Chinese and Euro-Caucasian Women in Canada

Chinese women in Western nations frequently report less engagement with sexuality, such as lower sexual response and behaviors, and more restrictive sexual attitudes, than their Euro-Caucasian peers. This difference is likely related to sexual conservatism within traditional Chinese culture, though the mechanisms underlying how culture influences sexual responding are not well understood. The current study investigated if these differences were consistent with the dual control model, a well-established model for understanding regulation of sexual response. Chinese and Euro-Caucasian women (N = 471; age M = 20.7 years, SD = 3.3) residing in Canada from a university sample completed self-report questionnaires on sexual excitation and inhibition, sexual attitudes, and various sexual response and behavior measures. Sexual excitation was significantly lower in Chinese than Euro-Caucasian women and was significantly associated with sexual response in both groups. Structural equation modeling showed that sexual response variables were associated with a latent sexual excitation factor and that sexual attitudes partially mediated the relationship between this latent factor and ethnicity. The findings showed that sexual excitation and sexual attitudes contribute to cross-cultural differences in women's sexual responding. Theoretical and clinical considerations are discussed.

Acceptability and Preliminary Efficacy of an Online HIV Prevention Intervention for Single Young Men Who Have Sex with Men Seeking Partners Online: The myDEx Project

Prevention of new cases of HIV among young gay, bisexual and other men who have sex with men (YGBMSM; ages 18-24) remains a priority. We developed and pilot tested an online intervention (myDEx) using a pilot randomized trial design with 180 online-recruited single YGBMSM who reported recent unprotected anal intercourse, self-reporting as HIV negative or status-unaware, and who met sexual partners through online dating applications. myDEx participants reported higher overall satisfaction (d = 0.46) and willingness to recommend the intervention to friends (d = 0.48) than controls. myDEx participants were less likely to report foregoing condoms to achieve an emotional connection with a partner (d =0 .43), and more likely to report greater emotional regulation during their partner-seeking behaviors (d = 0.44). myDEx participants reported fewer partners with whom they had condomless receptive anal sex (d = 0.48). Our pilot results demonstrate the potential of the myDEx intervention, suggesting that a larger efficacy trial may be warranted in the future.

The Somatic Marker Hypothesis and Sexual Decision Making: Understanding the Role of Iowa Gambling Task Performance and Daily Sexual Arousal on the Sexual Behavior of Gay and Bisexual Men

Background

The sexual decision-making literature suggests that sexual arousal and behavior are associated. The somatic marker hypothesis suggests that individual neuropsychological differences in decision making, as measured by the Iowa Gambling Task (IGT), may moderate these associations; however, this hypothesis has yet to be tested with event-level sexual behavior data.

Purpose

We hypothesized that (a) daily sexual arousal would be positively associated with likelihood of engaging in sex and condomless anal sex (CAS) and (b) IGT scores would moderate these associations such that the associations would be stronger among those with higher IGT scores.

Methods

We used daily diary data from 334 highly sexually active gay and bisexual men to examine the main and interaction effects of sexual arousal and IGT scores on sexual engagement and CAS.

Results

As hypothesized, daily sexual arousal was positively associated with greater odds of both sexual engagement and CAS with casual male partners. Individual-level IGT performance significantly moderated the day-level association between arousal and sexual engagement, which was stronger for men with higher IGT scores. There was no main effect of IGT scores on either sexual behavior outcome, nor did it moderate the association between arousal and CAS.

Conclusions

These findings highlight the influence of sexual arousal on sexual engagement, which differed by IGT scores; the effect of arousal on CAS was much less variable and may not be moderated by neurocognitive factors. This study supports the importance of exploring integrated behavioral/biomedical interventions to improve individual decision making to prevent HIV infection.

Impact of HIV risk perception on both pre-exposure prophylaxis and condom use

Risk perception is one of the several important factors impacting sexual health behaviours. This study investigated the evolution of HIV risk perception on pre-exposure prophylaxis adherence and condom use in men who have sex with men at high risk of HIV and associated factors. Group-based trajectory modelling helped in identifying patterns of risk perception, pre-exposure prophylaxis adherence and condom use over time. The association between the former and the latter two dimensions was then investigated. An estimated 61 per cent (p < 0.001) of participants perceiving low risk and 100 per cent (p < 0.001) of those perceiving high risk had systematic pre-exposure prophylaxis adherence, while an estimated 49 per cent (p < 0.001) and 99.8 per cent (p < 0.001), respectively, reported low-level condom use.

Do Difficulties Regulating Positive Emotions Contribute to Risky Sexual Behavior? A Path Analysis

Within the U.S., risky sexual behavior (RSB) is the primary mode of HIV transmission. The role of emotion dysregulation in RSB has received growing attention over the past decade. However, this literature has been limited in its focus on emotion dysregulation stemming from negative (but not positive) emotions. The goal of the current study was to extend research by examining the relative and unique contributions of dimensions of difficulties regulating positive emotions (i.e., nonacceptance of positive emotions [Accept], difficulties controlling impulsive behaviors when experiencing positive emotions [Impulse], and difficulties engaging in goal-directed behaviors when experiencing positive emotions [Goals]) to RSB. Participants were 386 trauma-exposed individuals recruited from Amazon's MTurk (M age = 35.85 years; 57.5% female; 76.4% White). At the bivariate level, dimensions of difficulties regulating positive emotions were significantly positively associated with sexual risk taking with uncommitted partners, impulsive sex behaviors, and intent to engage in risky sexual behaviors (with the exception of Goals to sexual risk taking with uncommitted partners), and significantly negatively associated with risky sex acts. Regarding the unique contributions of difficulties regulating positive emotions to RSB, (1) Accept was significantly positively associated with impulsive sexual behaviors and intent to engage in risky sexual behaviors; (2) Impulse was significantly positively associated with risky anal sex acts; and (3) Goals was significantly negatively associated with risky anal sex acts. Findings suggest the potential utility of targeting difficulties regulating positive emotions in treatments aimed at reducing RSB.

A dyadic approach to understanding safer sex behavior in intimate heterosexual relationships

This study applied a dyadic approach to condom-use research. Partners from 124 heterosexual couples independently completed a questionnaire assessing condom-related attitudes, subjective norms, perceived behavioral control, and intentions to use condoms. Results demonstrate the superiority of a dyadic approach to understanding couples’ condom-use intentions and behavior over traditional, individual-level approaches. The addition of partner effects to the model, via the actor–partner interdependence model, resulted in an increase in the variance accounted for in condom-use intentions and this dyadic model showed better fit compared to the individual-level model. The results suggest that consideration of relationship partners plays an important role in the prediction of safer sex intentions.

Age differences in attitudes toward safer sex practices in heterosexual men using an Australian Internet dating service

Background This cross-sectional study investigated sexually transmissible infection (STI) knowledge, safer sex attitudes and behaviours of sexually active, heterosexual men using an Internet dating service, and explored factors associated with protective attitudes.

METHODS

An anonymous online survey was sent to men who had logged onto an Internet dating service within the previous year. Factors associated with discussing STIs before sex and condom use intention with a new partner were analysed.

RESULTS

In total, 2339 responses were analysed. Men had lower STI knowledge scores, lower use of condoms and greater beliefs that condoms reduced interest in sex as age increased. Younger men (aged 18-29 years) were more likely to report intentions of only having sex with a new partner if a condom was used compared with older men aged over 60 years. Predictors of having a discussion about STIs with a new partner were older age, better knowledge of STIs, greater distress at a potential diagnosis of an STI and stronger future condom use intention. Intention to only have sex with a new female partner if a condom was used was associated with higher STI knowledge, discussing STIs with a new partner and distress at a diagnosis of an STI. Men with a higher number of sexual partners in the last year were less likely to have an STI discussion with new partners or intend to use a condom with a new partner.

CONCLUSIONS

Older Internet-dating, heterosexual men are vulnerable to STIs. Health promotion interventions to increase STI awareness, condom use and STI testing in older men are warranted.

Explaining the intention of dental health personnel to report suspected child maltreatment using a reasoned action approach

BACKGROUND

This study provides an empirical test of the reasoned action approach (RAA) socio-cognitive theory with the aim of 1) predicting the intention of public dental health personnel (PDHP) to report suspected child-maltreatment to child welfare services (CWS); 2) estimating the effects of the theoretical constructs of RAA, including experiential and instrumental attitudes, injunctive and descriptive norms, and perceived capacity and autonomy regarding PDHP's behavioural intentions; and 3) exploring whether the RAA operates equivalently (i.e., is invariant) in male and female providers.

METHODS

This national cross-sectional study was conducted in Norway. An electronic survey was distributed to 1542 dentists and dental hygienists working in the public dental health service. The survey included RAA items constructed in accordance with the recommendations for the RAA model. Structural equation modelling (SEM) was used to identify factors derived from the theory of RAA to predict PDHP reporting intentions.

RESULTS

A total of 77.8% (1200) of those surveyed responded to the survey. The present study provided support for the utility of the RAA across both male and female providers in predicting their intention to report suspected child-maltreatment to the CWS. The final modified SEM model revealed that instrumental attitudes and perceived behavioural control (based on merged capacity and autonomy parameters) were the strongest predictors of intention to report, followed by the reporting of descriptive norms, injunctive norms and experiential attitudes. These factors explained 63.6% of the observed variance in the reporting intention.

CONCLUSIONS

The large amount of explained variance suggests that RAA is a well-functioning theory that predicts PDHP's reporting intentions to CWS across gender, and gives an understanding of the socio-cognitive factors involved. To strengthen reporting intention among dental personnel, this study suggests educators should focus on the value and positive consequences of reporting, the resources available and how to overcome obstacles; attention to normative expectations and individuals' feelings about reporting may also be helpful.

The effectiveness of an educational intervention to enhance happiness in Iranian older people: Applying social support theory

OBJECTIVE

The aim of this study was to explore the effectiveness of an educational program based on social support theory (SST) to enhance happiness in older adults (60-75 years) in Hamadan (Iran) in 2017.

METHODS

This study was a quasi-experimental intervention with a control group, consisting of 60 participants and an intervention group of 40 participants. The research instruments included the Oxford Argyle Happiness Inventory and a questionnaire derived from SST.

RESULTS

The findings showed that there was a significant difference between the scores of happiness, social support and their components in the intervention group compared to the control group three months after the intervention.

CONCLUSION

The study results indicate that an educational intervention to promote happiness using social support can play a pivotal role in the mental health, life satisfaction and happiness of older adults.

Anxiety and Performance in Sex, Sport, and Stage: Identifying Common Ground

Anxiety has long been associated with diminished performance within a number of domains involving evaluative interpersonal interactions, including Sex, Sport, and Stage. Here, we pose three questions: (1) how do these disparate fields approach and understand anxiety and performance; (2) how does the understanding of the issue within one field offer insight to another field; and (3) how could each field benefit from the ideas and strategies used by the others. We begin with a short review of models of anxiety/arousal and performance and then explore definitions, models, presumed underlying physiological processes, and characterizing and influencing factors within each domain separately in a narrative review. This discussion is followed by a synthesis that identifies elements specific to and common across the various domains, with the latter captured in a model of essential characteristics. Concluding remarks note the potential value of promoting increased cross-disciplinary conversation and research, with each domain likely benefiting from the conceptualizations and expert knowledge of the others.

Understanding the barriers and factors to HIV testing intention of women engaging in compensated dating in Hong Kong: The application of the extended Theory of Planned Behavior

Background

Women engaging in compensated dating is one of the at risk group of HIV infection due to multiple sexual partnerships and risky sexual practices. The present study examined the prevalence of HIV testing behavior and intention, and identified factors associated with HIV testing intention among women engaging in compensated dating in Hong Kong. Factors from the Theory of Planned Behaviors and the role of various types of barriers to HIV testing were also explored.

Methods

An anonymous, cross-sectional survey was conducted online. Target participants were women who have engaged in compensated dating and provided sex services to clients. Participants were recruited via three sources, including i) online outreaching, ii) referral made by NGOs, and iii) referral made by participants. A total of 183 participants completed the study.

Results

Respectively 29.7% and 18.6% have taken up HIV testing and showed intention to take up HIV testing in the future year. Results from the multiple hierarchical regression model showed that having ever received HIV testing (β = 0.44, p < .001), attitudes towards HIV testing (β = 0.22, p < .01), subjective norm (β = 0.18, p < .05), perceived behavioral control (β = 0.18, p < .01) and perceived discrimination from health care workers (β = -0.24, p < .05) significantly predicted intention to take up HIV testing.

Conclusion

The present study demonstrates the applicability of extended TPB in HIV testing intention among women engaging in compensated dating. Interventions to promote HIV testing among this group are greatly warranted.

Longitudinal Predictors of Behavioral Intentions and HIV Service Use Among Men Who Have Sex with Men

HIV prevention interventions are generally effective at reducing sexual risk. Although these interventions have been widely disseminated in the USA, their success depends largely on whether subpopulations who have been prioritized for risk reduction are willing to participate. Understanding the factors predicting service utilization is critical to maximizing public health benefit. HIV-negative men who have sex with men (MSM) (n = 613) were enrolled in a longitudinal study investigating whether theoretically derived psychosocial variables (past behavior, cues to action, perceived susceptibility, positive expectations, perceived barriers, personal discomfort, and recent condomless anal intercourse) predicted intentions to use HIV prevention services and service use behavior across multiple categories (information seeking, structured service use, HIV testing, and volunteering/working in prevention services). Cues to action (including life events such as friend's recent HIV diagnosis) and past service use emerged as the most consistent predictors of intentions and actual service use. Perceived susceptibility, positive expectations, and condomless anal intercourse predicted some categories of service use indirectly through intentions. Contrary to predictions, perceived barriers and personal discomfort predicted intentions but were not predictors of service use. Intentions generally predicted behavior, with the exception of structured service use. This study addressed methodological limitations of prior research and utilized data from a longitudinal sample of MSM to discover predictors of access to HIV prevention services. Understanding who accesses HIV services and why will allow for directed strategies to improve dissemination and utilization.

Predicting Intentions to Breastfeed for Three Months, Six Months, and One Year Using the Theory of Planned Behavior and Body Satisfaction

Breastfeeding is one of the top maternal priorities for many organizations, including the World Health Organization (WHO), The American Academy of Pediatrics (AAP), and the Center for Disease Control (CDC). Focusing on the goals of Healthy People 2020, as well as the recommendations of other organizations, this paper investigates the impacts on women's intentions to breastfeed newborns for 3 months, 6 months, and 1 year. This research used the theory of planned behavior (TPB) as a model to predict intentions for each duration of time. Body satisfaction was included as a moderating variable given research demonstrating a possible connection of body satisfaction to breastfeeding. A survey of 156 pregnant women was conducted. Results demonstrated the importance of the three TPB measures in predicting intentions. Further, significant interactions between body satisfaction and attitudes, as well as body satisfaction and subjective norms were present in predicting intentions to exclusively breastfeed one's baby from infant to 6 months of age. Theoretical implications are discussed, as well as practical implications for breastfeeding interventions and campaigns.

Does attractiveness influence condom use intentions in women who have sex with men?

Objectives

Attractiveness judgements have been shown to affect interpersonal relationships. The present study explored the relationships between perceived attractiveness, perceived sexual health status, condom use intentions and condom use resistance in women.

Setting

The study data were collected using an online questionnaire.

Participants

480 English-speaking women who have sex with men, between 18–32 years old.

Outcome measures

Women were asked to rate the attractiveness of 20 men on the basis of facial photographs, to estimate the likelihood that each man had a sexually transmitted infection (STI), and to indicate their willingness to have sex with each man without a condom. Condom resistance tactics were also measured and their influence on condom use intentions was assessed.

Results

The more attractive a man was judged to be, the more likely it was that participants were willing to have sex with him (r (478) = 0.987, p < .001). Further, the more attractive a man was judged to be, the less likely women were to intend to use a condom during sex (r = -0.552, df = 478, p = .007). The average perceived STI likelihood for a man had no significant association with his average perceived attractiveness or with participants’ average willingness to have sex with him. The more attractive a participant judged herself to be, the more she believed that, overall, men are likely to have a STI (r = 0.103, df = 478, p < .05).

Conclusions

Women’s perceptions of men’s attractiveness influence their condom use intentions; such risk biases should be incorporated into sexual health education programmes and condom use interventions.

Effects of a computerized psychological inoculation intervention on condom use tendencies in sub Saharan and Caucasian students: two feasibility trials

Objective: An effective method for preventing the Human Immunodeficiency Virus (HIV) is condom use. Yet, research shows limited effects of education on increasing condom use. This research examined the effects of psychological inoculation (PI) versus education on condom use -barriers and -tendencies, using a fully automatized online system. Design: Two randomized controlled trials. In Study 1, 59 Sub-Saharan students were included while Study 2 20 European students were included. In both studies, participants were randomly assigned to PI or control conditions. In Study 2, we additionally matched pairs on gender and condom barriers. In the PI, participants received challenging sentences they had to refute. Main outcome measures: An indirect condom use test (I-CUTE) and a condom use barriers questionnaire, assessed at baseline and a month later. Results: In Study 1, a significant increase in I-CUTE scores and no change in barriers was found in the PI condition. Controls did not change on either outcome. In Study 2, two sub-scales of condom barriers (concerning partner and satisfaction) were significantly decreased in the PI group, while in controls, barriers significantly increased over time. In both groups, I-CUTE scores tended to increase. Conclusions: These results replicate previous studies and extend them to a fully automatized system without counselors.

Annual Research Review: The state of implementation science in child psychology and psychiatry: a review and suggestions to advance the field

BACKGROUND

Scientists have developed evidence-based interventions that improve the symptoms and functioning of youth with psychiatric disorders; however, these interventions are rarely used in community settings. Eliminating this research-to-practice gap is the purview of implementation science, the discipline devoted to the study of methods to promote the use of evidence-based practices in routine care.

METHODS

We review studies that have tested factors associated with implementation in child psychology and psychiatry, explore applications of social science theories to implementation, and conclude with recommendations to advance implementation science through the development and testing of novel, multilevel, causal theories.

RESULTS

During its brief history, implementation science in child psychology and psychiatry has documented the implementation gap in routine care, tested training approaches and found them to be insufficient for behavior change, explored the relationships between variables and implementation outcomes, and initiated randomized controlled trials to test implementation strategies. This research has identified targets related to implementation (e.g., clinician motivation, organizational culture) and demonstrated the feasibility of activating these targets through implementation strategies. However, the dominant methodological approach has been atheoretical and predictive, relying heavily on a set of variables from heuristic frameworks.

CONCLUSIONS

Optimizing the implementation of effective treatments in community care for youth with psychiatric disorders is a defining challenge of our time. This review proposes a new direction focused on developing and testing integrated causal theories. We recommend implementation scientists: (a) move from observational studies of implementation barriers and facilitators to trials that include causal theory; (b) identify a core set of implementation determinants; (c) conduct trials of implementation strategies with clear targets, mechanisms, and outcomes; (d) ensure that behaviors that are core to EBPs are clearly defined; and (e) agree upon standard measures. This agenda will help fulfill the promise of evidence-based practice for improving youth behavioral health.

A Longitudinal Examination of Posttraumatic Stress Disorder Symptoms and Risky Sexual Behavior: Evaluating Emotion Dysregulation Dimensions as Mediators

Posttraumatic stress disorder (PTSD) has been linked to a wide array of risky and health-compromising behaviors, including risky sexual behavior (RSB). Cross-sectional studies reveal positive associations between emotion dysregulation and both PTSD and RSB. This study extended that work by exploring whether intermediate levels of emotion dysregulation across multiple dimensions account for the relation between baseline PTSD symptoms and RSB (i.e., number of vaginal sex partners, number of instances of condomless sex, and number of instances of risky/impulsive sex) 16 months later. Participants were 447 trauma-exposed young adult women from the community (60.0% White; M age = 21.80 years) who completed five assessments (separated by 4-month increments) over a 16-month period. Baseline PTSD symptoms were significantly positively associated with all emotion dysregulation dimensions at 8 months and the number of instances of risky/impulsive sex at 16 months. Further, results revealed significant indirect effects of baseline PTSD symptoms on (1) 16-month vaginal sex partners through both the nonacceptance of negative emotions and difficulties controlling impulsive behaviors when distressed at 8-month and (2) 16-month risky/impulsive sex through difficulties engaging in goal-directed behaviors when distressed at 8 months. Results provide support for the mediating roles of nonacceptance of negative emotions and difficulties controlling behaviors when distressed in the relation between PTSD symptoms and later RSB.

Sharing and helping: predictors of adolescents' willingness to share diabetes personal health information with peers

Objective

Sharing personal information about type 1 diabetes (T1D) can help adolescents obtain social support, enhance social learning, and improve self-care. Diabetes technologies, online communities, and health interventions increasingly feature data-sharing components. This study examines factors underlying adolescents' willingness to share personal T1D information with peers.

Materials and Methods

Participants were 134 adolescents (12-17 years of age; 56% female) who completed an online survey regarding experiences helping others with T1D, perceived social resources, beliefs about the value of sharing information and helping others, and willingness to share T1D information. Hemoglobin A1c values were obtained from medical records.

Results

Adolescents were more willing to share how they accomplished T1D tasks than how often they completed them, and least willing to share glucose control status. In multivariate analyses, sharing/helping beliefs (β = 0.26, P < .01) and glucose control (HbA1c value; β = -0.26, P < .01) were related to greater willingness to share personal health information. Glucose control moderated relationships such that adolescents with worse A1c values had stronger relationships between sharing/helping beliefs and willingness to share (β = 0.18, P < .05) but weaker relationships between helping experience and willingness to share (β = -0.22, P = .07).

Discussion

Many adolescents with T1D are willing to share personal health information, particularly if they have better diabetes health status and a stronger belief in the benefits of sharing.

Conclusion

Social learning and social media components may improve intervention participation, engagement, and outcomes by boosting adolescents' beliefs about the benefits of sharing information and helping others.

Understanding Young Adults' E-cigarette Use through the Theory of Planned Behavior

OBJECTIVE

The use of e-cigarettes among college undergraduates is a prevalent problem across the United States. Guided by the Theory of Planned Behavior (TPB), we examined the relationship between memorable messages and early adulthood e-cigarette use.

METHODS

We recruited 159 students to complete a survey at Time 1 and 126 of those students completed the second survey.

RESULTS

Structural equation modeling demonstrated that attitudes and norms are significantly associated with intentions to use e-cigarettes, whereas efficacy is negatively associated with intentions to use. Intentions were positively associated with actual use of e-cigarettes at Time 2.

CONCLUSIONS

Our findings contribute to understanding young adults' experiences with alternative tobacco products, and demonstrate a need to create health education and promotion campaigns based on TPB constructs.

ERPs Reveal Disengagement Processes Related to Condom Use Embarrassment in Intention-Behavior Inconsistent Young Adults

The use of barrier protections such as condoms has consistently been reported to reduce the acquisition of sexually transmitted infections. However, it has also been reported that the association between condom use intentions and behavior is, at best, often weak. Furthermore, embarrassment associated with purchasing condoms and negotiating their use has been shown to negatively impact the frequency of condom use. Using electroencephalography to analyze P300 event-related potential components known to measure early attention allocation, we examined electrophysiological evidence of early attention disengagement for embarrassing health information. Forty young adults-34 females and six males-participated in an adapted version of Posner's visual cueing paradigm. All were high in intention to use condoms, but half were intention-behavior consistent and half were intention-behavior inconsistent. Compared to intention-behavior consistent participants, those with intention-behavior inconsistency showed a reduced P300 component when attending to a visual target opposite to the field in which embarrassing self-relevant health information was presented, indicating more efficient early attention disengagement from such embarrassing health information. In conclusion, our electrophysiological data suggest that high intention alone may be not sufficient to predict adolescents' condom use behavior.

Influences on safety consciousness in a utility company: A sequential mediation model

INTRODUCTION

The purpose of this research was to determine whether the influence of supervisory support for safety on safety consciousness is direct or indirect. Based in part on predictions from the Theory of Reasoned Action (TRA) and Social Cognitive Theory (SCT), we examined the extent to which belief (safety self-efficacy) and attitude (cavalier safety attitude) mediate the impact of supervisory support for safety on employee safety consciousness.

METHOD

A survey of 995 employees was distributed across 24 work groups in an electric utility company, and sequential mediation modeling was used to determine indirect effects on safety consciousness.

RESULTS

We found that the effect of supervisory support on safety consciousness was indirect, fully mediated through both efficacy and attitude in a sequential mediation model. Practical applications: Supervisors should be aware of and emphasize supportive behaviors and create welcoming conditions for employees to raise safety concerns. Furthermore, organizational programs pertaining to safety improvement need to consider how to develop positive beliefs regarding safety activity and attitudes and reduce negative ones.

Sexual Arousal and Implicit and Explicit Determinants of Condom Use Intentions

Being sexually aroused may be an important risk factor contributing to sexual decision making. Dual-process cognitive models, such as the reflective-impulsive model of Strack and Deutsch (2004), could be used to explain the effect of sexual arousal on intentions to use a condom. In this study, we investigated whether explicit and implicit attitudes toward condom use can predict intentions to use a condom when participants are sexually aroused and not aroused. In a within-subjects experimental design, male participants (N = 27) watched both a neutral and an erotic movie clip in counterbalanced order. After each clip, participants completed a questionnaire assessing their intentions to use a condom and explicit condom attitudes, followed by a wanting Implicit Association Test (IAT; Greenwald et al., 2003) and a liking IAT to assess their implicit attitudes to unsafe sex. In concordance with the reflective-impulsive model, we found that when participants were not sexually aroused, their intentions to use a condom were solely predicted by their explicit attitudes. However, when they were sexually aroused, intentions to use a condom were predicted by both explicit and implicit attitudes toward condom use.

Developing and testing a web-based intervention to encourage early help-seeking in people with symptoms associated with lung cancer

OBJECTIVES

To detail the development method used to produce an online, tailored, theory-based, user-centred intervention to encourage help-seeking for potential lung cancer symptoms.

DESIGN

Intervention development was structured around the person-based approach. The feasibility study involved a randomized controlled trial design.

METHODS

Intervention development drew on qualitative inquiries, the Theory of Planned Behaviour (TPB), and identifying concrete mechanisms of change to implement in the intervention (Behaviour Change Techniques). The final intervention involved two key features: (1) tailoring and (2) 'TPB components' to target beliefs about help-seeking. In an online feasibility study, we recruited people reporting potential lung cancer symptoms using mailing lists, social media, websites, and Google AdWords. Participants were randomized to the intervention, a tailored comparison group (CG) without TPB-components, an untailored CG with TPB components, or a CG with neither. Following treatment, participants clicked a button to indicate whether they wished to make an appointment and completed a TPB questionnaire.

RESULTS

A total of 130 participants reporting relevant symptoms were recruited (24% of website visitors). Participants in the intervention group reported higher intention to seek help than those who received tailored information without TPB components (p = .03). User comments indicate more support is needed for people who sought help for symptoms, but felt dismissed.

CONCLUSIONS

The potential for differential dropout in online randomized trials requires careful consideration. Future help-seeking interventions should provide support for those who have previously felt dismissed by health professionals. The feasibility study provides some evidence that our 'TPB components' were effective, but validation in a powered trial is necessary. Statement of contribution What is already known on this subject? People with lung cancer often delay presenting symptoms to health services. Some patients (or their family/friends) look up symptoms online before their diagnosis, to decide whether they should see a doctor. Interventions are needed to ensure people can find useful information online that will encourage them to seek help for relevant symptoms. What does this study add? Theory-mapping and user involvement facilitated systematic intervention development. Lung cancer help-seeking interventions should address salient beliefs and personal relevance. The potential for differential dropout in online randomized trials requires careful consideration.

Closeness Discrepancies and Intimacy Interference: Motivations for HIV Prevention Behavior in Primary Romantic Relationships

Relational closeness has been positively associated with relationship quality and mental health; however, desire for closeness and intimacy in a relationship may also motivate sexual risk-taking, that is, forgoing condom use. This study examined the impact of desiring more closeness with a primary partner (i.e., motivation for reducing closeness discrepancies) on HIV prevention behavior. Using pre-exposure prophylaxis (PrEP) as a case study, we examined the extent to which closeness discrepancies motivate behavioral intentions (Study 1) and actual behavior (Study 2). In both studies, desiring more closeness and believing that condoms interfere with intimacy were independently positively associated with PrEP adoption. Understanding the relational needs for closeness and intimacy in motivating prevention behavior is critical for social psychology, relationship science, and public health efforts to improve sexual health.

Multi-contextual influences on adolescent pregnancy and sexually transmitted infections in the United States

RATIONALE

Rates of adolescent pregnancy and sexually transmitted infections (STIs) in the United States remain high. Norms and beliefs about sex and the use of contraception have been identified as potential contributors to these.

OBJECTIVE

The current study examined multi-contextual links between norms and beliefs about sex and contraception, and adolescent pregnancies and STIs.

METHOD

Hierarchical linear modeling (HLM) was used to test the study questions in the historical data from Add Health dataset (Wave I, 1994-1995, and Wave II, 1995-1996). Measures of beliefs about sex and contraception were administered to adolescents and their caregivers; pregnancies and STIs were reported by adolescents (N = 13,568; level 1). School-reported data (N = 132; level 2) included sexuality education and prevalence of pregnancies at schools. Community data included the density of family planning providers in each county.

RESULTS

Adolescents negative beliefs about contraception were associated with a higher likelihood of pregnancies and STIs via their association with contraception use. The opposite effect was found for negative beliefs about sex. Parental disapproval of contraception was associated with a decreased likelihood of STIs, but with an increased likelihood of pregnancies. A greater number of pregnancies at school was associated with a greater likelihood of STIs. Unexpectedly, the number of county-level family planning providers was associated with a higher likelihood of STIs.

CONCLUSION

Adolescent individual beliefs emerged as the most salient predictors of both pregnancies and STIs.

Childbearing intentions in a low fertility context: the case of Romania

This paper applies the Theory of Planned Behaviour (TPB) to find out the predictors of fertility intentions in Romania, a low-fertility country. We analyse how attitudes, subjective norms and perceived behavioural control relate to the intention to have a child among childless individuals and one-child parents. Principal axis factor analysis confirms which items proposed by the Generation and Gender Survey (GGS 2005) act as valid and reliable measures of the suggested theoretical socio-psychological factors. Four parity-specific logistic regression models are applied to evaluate the relationship between the socio-psychological factors and childbearing intentions. Social pressure emerges as the most important aspect in fertility decision-making among childless individuals and one-child parents, and positive attitudes towards childbearing are a strong component in planning for a child. This paper also underlines the importance of the region-specific factors when studying childbearing intentions: planning for the second child significantly differs among the development regions, representing the cultural and socio-economic divisions of the Romanian territory.

Predicting College Student Drinking and Smoking Intentions With Cognitively Accessible Attitudes and Norms

Understanding the factors that make college students more likely to drink alcohol and smoke cigarettes is key to developing effective interventions in order to reduce these behaviors. This study sought to understand entering college students' intentions to engage in smoking and drinking behavior by examining the cognitive accessibility (ease of retrieval from memory) of attitudes and norms for drinking. A sample of 413 first-year college students living in on-campus residence halls participated in the study in the first 2 weeks of their first semester of college. Reaction time measures of attitudes and norms assessed the cognitive accessibility of these constructs. Hierarchical linear regression analysis was conducted. Results indicated that the cognitive accessibility of both attitudes and peer injunctive norms predicted behavioral intentions to drink and smoke. Our findings indicate that when injunctive peer norms are accessible from memory, they are better predictors of drinking and smoking intentions than descriptive norms or injunctive family norms. Our work provides important guidance for interventions to reduce risky behavior in college students and suggests that emphasizing social costs of these behaviors may be a promising strategy.

The Mechanisms of Social Norms’ Influence on Consumer Decision Making

Abstract. In the past decades, marketing practitioners have embraced social norms as a powerful instrument of influencing consumers’ behavior. An important distinction has been made between descriptive norms (what most others do) and injunctive norms (what others approve of), and this meta-analysis across 297 studies examines the effects of these types of social norms on consumer decision-making processes. We argue that descriptive norms directly influence behavior, and consequently that their effect on behavior should be stronger than that of injunctive norms. Injunctive norms, by contrast, should be more strongly related to intentions than descriptive norms. Results of the meta-analysis support these predictions, and furthermore provide new insights into the moderating effects of aspects of the norm (specificity of the norm, norm source) and of the target person (gender, age).

Causal Effects of Alcohol Intoxication on Sexual Risk Intentions and Condom Negotiation Skills Among High-Risk Men Who Have Sex with Men (MSM)

Alcohol use is a key risk factor for HIV infection among MSM, in part because intoxication may interfere with the use of prevention methods like condoms. However, few studies have examined whether this is due to alcohol's pharmacological or expectancy effects or explored the specific aspects of sexual decision-making that may be affected. In this study, high-risk, heavy drinking MSM (N = 121) were randomly assigned to receive either (1) alcohol beverages, (2) placebo beverages, or (3) control beverages, before navigating a video-based sexual risk scenario that assessed several aspects of sexual decision-making. Results showed that condom use intentions and negotiation behaviors were lower among alcohol and placebo participants compared with controls, but that few significant differences emerged between the alcohol and placebo groups. These findings contrast with similar past studies, and suggest that alcohol's expectancy effects may play a role in sexual decision-making.

Exploring Mechanisms of Narrative Persuasion in a News Context: The Role of Narrative Structure, Perceived Similarity, Stigma, and Affect in Changing Attitudes

Two exploratory studies demonstrate, for the first time, that narrative persuasion can diminish the stigma attached to social groups featured in journalistic narratives. Study 1 shows narrative format improves stigma toward Syrian refugees indirectly through narrative engagement, perceived similarity, and meaningful affect. Decreases in stigma also improved attitudes toward refugees. Study 2 replicates these findings against a separate participant pool, an additional story topic, and compares changes in engagement, stigma, and attitude to a non-narrative fact sheet and a control condition. A preregistered third study seeks to validate the finding that narratives can elicit destigmatization and disentangle the roles of story exemplars from story structure.

An Application of the Reasoned Action Approach to Bystander Intervention for Sexual Assault

The high prevalence of sexual assault in US college campuses has led to a widespread implementation of bystander intervention programs aimed at preventing sexual assault. The current study examines predictors of college students' intentions to engage in bystander intervention through the theoretical lens of the reasoned action approach. An online survey with college students (N = 186) was conducted at a large Midwestern university. Our results indicated experiential attitudes, instrumental attitudes, descriptive norms, autonomy, and capacity, each positively associated with participants' intentions to intervene to stop a sexual assault. Against expectations, injunctive norms were unrelated to bystander intervention intentions. Finally, in addition to these main effects, an experiential attitude by autonomy interaction was also observed. The results are discussed with a focus on the theoretical and practical implications of our findings.

Application of Core Processes for Understanding Multiple Concurrent Sexual Partnerships Among Adolescents in Uganda

Introduction: Adolescents in Uganda, as in other sub-Saharan countries, engage in sex with multiple concurrent partners, thus placing them at risk for HIV and unplanned pregnancies, but it is not clear why. This study explored why adolescents in Uganda engage in multiple concurrent sexual partnerships (MCSP). Methods: This study used a Core Processes methodology. We used the processes of brainstorming, and identification of evidence and theoretical support, in various phases/steps of intervention planning, to provide possible explanations for adolescent MCSP. Results: Adolescents were found to have limited knowledge of the risks associated with MCSP and perceived a low risk for HIV. Peer influence to engage in MCSP exacerbated the problem among adolescents. Poor communication with sexual partners and parents and societal indifference to multiple sexual partnerships increased permissive attitudes toward infidelity. The unclear adolescent sexual and reproductive health policies hampered access to services, and transactional sexual relationships with older (polygamous) sexual partners increased the HIV risk. Adolescents were found to be more concerned about unplanned pregnancies than HIV risk. Discussion: From the empirical evidence, adolescent health programs in Uganda should incorporate comprehensive sexual health education on HIV and teenage pregnancy risk-reduction strategies. Programs should strengthen parental and community support through enhanced collaborative training on communication with and for adolescents. Forming strategic partnerships with various stakeholders for concerted efforts to address the MCSP problem among adolescents is critical.

Sexual risk among Colombian adolescents: knowledge, attitudes, normative beliefs, perceived control, intention, and sexual behavior

BACKGROUND

Colombia has one of the highest rates of the human immunodeficiency virus (HIV) and pregnancies - both of which are influenced by lack of condom use -, among adolescent population in Latin America; however, the mechanisms underlying the inconsistent use of condoms in this population are poorly understood. This descriptive and cross-sectional study's purpose was to examine sexual behavior and its precursors using the theory of planned behavior (TPB) and considering gender-based differences. Another objective was to study the mediating effect of intention in the relationship between behavior precursors and condom use based on the TPB.

METHODS

We recruited 1100 adolescents aged between 14 and 19 years old (M = 15.94, SD = 1.30, 54.4% female) from Bogotá and Barranquilla, two of the cities with highest adolescent birth rates among adolescents in Colombia. Sociodemographic variables, knowledge on HIV and other sexually transmitted infections (STIs), HIV/AIDS-related attitudes, including attitudes toward the use of condoms, normative beliefs, perceived behavioral control, behavioral intention, and sexual behavior were assessed using self-reports. All analyses were run using SPSS v25. The indirect effect of intention to explain the relationship between precursors and the use of condoms during sexual intercourse was estimated using the PROCESS v3 macro.

RESULTS

Descriptive analyses suggest a high risk of contracting sexually transmitted infections and unplanned pregnancies associated to inconsistent condom use, medium-low level of knowledge about sexual health, low normative beliefs regarding peers' condom use, and a certain perceived difficulty for using condoms. Condoms are used 71% of the times they have sex, but only 22% of the participants use them consistently; girls use condoms more consistently than boys. Sexual risk characteristics differed significantly by gender. Mediation analyses indicated that condom use intention mediates the relationship between behavioral precursors and frequency of condom use, according to the TPB.

CONCLUSIONS

Findings provide a better understanding of sexual risk and highlight important implications for the sexual and reproductive health of adolescents. There is a need of designing and implementing protocolized sexual health promotion programs in schools with the aim of reducing sexual risk behaviors in Colombian adolescents.